Six Sigma as a Healthcare
Quality Initiative
The Quality Colloquium
August 21-24, 2005
Carolyn Pexton, GE Healthcare
Benjamin Williams, Harvard Health Policy Review
Track IC – August 22, 1:45-6:15
Date
Six Sigma Basics
Benjamin Williams
Former Editor-in-Chief, Harvard Health Policy Review;
Former Administrative Resident & Six Sigma Green Belt, NewYork-Presbyterian Hospital
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
History & Early Pioneers
• “Six Sigma” coined at
in the 1980s
• Adopted by Allied Signal (Honeywell) with great success
• Later adopted by Jack Welch (GE) and further developed
into a true management system
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
What is Six Sigma?
A philosophy that underlies efforts to
improve business performance and
customer satisfaction
• Using facts and data to eliminate waste (muda)
and variation
– Eliminating activities that don’t add value!
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
What is Six Sigma?
1.
The term “Sigma” is a measurement of how far a given
process deviates from perfection – a measure of number
of “defects”. “Six Sigma” implies near zero defects.
2.
“A quality improvement methodology that applies
statistics to measure and reduce variation in processes.”
3. A management system that is “comprehensive and
flexible for achieving, sustaining, and maximizing
business success.”
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Conceptual Framework
•
Critical to Quality (CTQ): Attributes most important to the customer
•
Defect: Failing to deliver what the customer wants
•
Process Capability: What your process can deliver
•
Stable Operations: Ensuring consistent, predictable processes to
improve what the customer perceives
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Measurement: Variance is the Enemy
Mean
Mean
Time Intervals
Time Intervals
W I D E Variation
Ex: MRI TAT Project
Slim Variation
Target
Target
Customer
Upper Limit
DEFECTS
Time (Min.).
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Customer
Upper Limit
ZERO
DEFECTS
Time (Min.).
Measurement: Six Sigma as a Quality Goal
The higher the sigma, the
3 fewer the defects.
A increase from 3 to 6 Sigma
represents a 20,000 fold
improvement in quality.
σ
Defects Per
Million
Opportunities
1
2
3
4
5
6
697,672.15
308,770.21
66,810.63
6,209.70
232.67
3.40
99% “Good” (3.8 Sigma)
99.99966% “Good” (6 Sigma)
No electricity for 7 hours per month
No electricity for 1 hour every 34 years
5,000 incorrect operations per week
1.7 incorrect operations per week
20,000 wrong prescriptions per year
68 wrong prescriptions per year
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Measurement: Comparative Analysis of
Process Capability
DPMO
IRS - Tax Advice
(phone-in)
(140,000 PPM)
1,000,000
100,000
Restaurant Bills
Doctor Prescription Writing
Payroll Processing
Order Write-up
Journal Vouchers
Wire Transfers
Airline Baggage Handling
10,000
•
1,000
100
Purchased Material
Lot Reject Rate
Best-in-Class
10
Average
Company
1
1
2
3
4
Domestic Airline Flight
Fatality Rate (0.43 PPM)
5
Sigma
© 1994 Dr. Mikel J. Harry - V4.0
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
6
7
Improvement Methodology: DMAIC “Backbone”
Sustain
improvement
Performance
Improvement
Devise solution(s) and
implement
Benchmarking
…and validate root cause(s)
…the current process capability
(get the data!)
…the problem in a measurable way
Project Timeline
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Return on Investment (ROI)
Control Tools
Improvement Methodology: Key Players
Champions/Sponsors: Trained business leaders who lead the
deployment of Six Sigma in a significant business area
Master Black Belts: Fully-trained quality leaders responsible for
Six Sigma strategy, training, mentoring, deployment and results
Black Belts: Fully-trained Six Sigma experts who lead
improvement teams, work projects across the business
and mentor Green Belts
Green Belts: Fully-trained individuals who apply
Six Sigma skills to projects in their job areas
Team Members: Individuals who
receive specific Six Sigma training
and who support projects in their
areas
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Management System: Themes
 Customer Focus
 Data- and Fact-Driven Management
 Process is Key
 Proactive Management
 “Boundaryless” Collaboration
 Drive for Perfection; Tolerate Failure
Source: Adopted from “The Six Sigma Way”
by P. Pande, R. Neuman, and R. Cavanagh
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Scalable Implementation
• Problem Solving
• Strategic Improvement
• Full-Scale Business Transformation
Source: Adopted from “The Six Sigma Way”
by P. Pande, R. Neuman, and R. Cavanagh
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
How is Six Sigma Different?
Other Quality Programs
Six Sigma
• Driven internally
• Driven by the customer
• Looks at averages
• Targets variation
• Focuses on outcomes
• Focuses on processes
• Retrospective; fixes defects
• Prospective; prevents defects
• Focuses on quality
• Focuses on quality & ROI
• Attentive to production
• Attentive to total business
• Training is separate from
management system
• Training is integral to
management system
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Industry $uccess!
In a study of Motorola, Allied Signal, GE, and
Honeywell -- companies with mature Six Sigma
deployments and associated culture changes -savings as a percentage of revenue were observed to vary
between 1.2% and 4.5%.
Charles Waxer (2003), “Six Sigma Costs And Savings”
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Industry Success Quality & Innovation
General Electric
-
Reduced invoice defects and disputes with a key customer by 98%
-
Improved a key call center performance measure from 76% to 99%
-
Reduced vibrations in Power System rotors by 300%
-
Developed breakthrough technology that reduced medical scan times from 3
minutes to 30 seconds
Allied Signal (Honeywell)
-
Reduced defects by 68% in 4 months
Texas Instruments
-
Improved yield from 84.3% to 99.8% since 1998
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Industry Pursuing Six Sigma

FedEx

Texas Instruments

Kodak

Sony

Hitachi

Dupont

Toshiba

Honda

Bank of America

Nokia

Raytheon

IBM

American Express

Lockheed Martin

Bombardier

Oracle

Siemens

Maytag

Amazon.com

Honeywell

Canon
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Applying Six Sigma and Related
Methods in Healthcare
Carolyn Plexton
GE Healthcare
Director of Communications,
Performance Solutions
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
How Safe is Healthcare?
44,000 to 98,000 Preventable Hospital
Deaths
(IOM study, 1999)
In-Hospital Deaths from Medical
Errors at 195,000 per Year. Patient
Safety Incidents In Hospitals Account
for $6 Billion per Year in Extra Costs
(HealthGrades - July, 2004)
Defects in healthcare are costly -- unlike manufacturing, you can’t
simply shut down the line until you find and fix the problem.
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Defects per Million Opportunities
Healthcare Fails to Deliver Six Sigma
790,000
1 Sigma
800000
580,000
700000
600000
500000
400000
2 Sigma
300000
210,000
200000
3.4
100000
0
5 Sigma
6
Sigma
Source: Chassin, Milbank Quarterly, 11/4/98.
3 Sigma
10,000
Hospitalized
Patients
Injured by
Negligence
Treatment of
Appropriate
Ambulatory Identification &
Patients with Treatment of
Antibiotics for Patients with
Viral
Clinical
Respiratory
Depression
Conditions
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Administration
of Beta
Blockers to
Elderly
Patients
Following
Heart Attack
Healthcare Project Examples
Improving process/safety for medication administration
Reduction in Blood Stream Infections in ICU
Reducing ventilator acquired pneumonia
Stroke Patient Length of Stay
Reduced Number of Inpatient Transfers
Emergency Department Patient Wait Time
Improved Patient Throughput in Radiology
Reduction in Lost Films
MR Exam Scheduling Improvement
Staff Recruitment and Retention
Operating Room Case Cart Accuracy
Physician (Professional Fee) Billing Accuracy
Appointment Backlog for Hospital-Based Orthopedic Clinic
Quality of Care and Satisfaction of Families in Newborn ICU
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Mitigating risk in clinical care
Improve medication administration
Increase compliance with care protocols
Remove conflict in coordinating care
Reduce post-surgical infections
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Focus areas include:
Clinical outcomes
Infection control
Case management
Patient safety
The Big “Why”
Achieving 35% higher
“take home baby”
rate with increase in
successful
implantation at
Women & Infant’s
Hospital, RI.
Better patient safety
with 91% improvement
in post-surgery
antibiotic use,
delivering annual
savings over $1 million
at Charleston Area
Medical Center, WV.
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Shorter ED wait
times allow 28 more
patients per day to
be seen, with
potential financial
impact over $13
million annually at
Verdugo Hills
Hospital, CA.
Supporting Major Initiatives
IHI’s 100k Campaign
Baldrige Award
Projects to improve patient safety in
key areas:
• Deployment of Rapid Response
Teams
• Delivery of Reliable, Evidence-Based
Care for Acute Myocardial Infarction
• Prevention of Adverse Drug Events
• Prevention of Central Line Infections
• Prevention of Surgical Site Infections
• Prevention of Ventilator-Associated
Pneumonia
Six Sigma helps to identify the right opportunities, target critical
underlying factors and maintain measurable improvement
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Key Success Factors
•
CEO must own it and must have a clear vision for the initiative
•
Invest in resources and make a long term commitment
•
Dedicate “best and brightest”
•
Measure and hold people accountable
•
Change the systems and structures to support the effort
•
Establish early, ongoing and clear communications
•
Be flexible and patient
•
Select and scope projects carefully: Focus on critical issues tied to
business priorities, with measurable and manageable parameters
•
Use change management tools to identify cultural barriers, gain
acceptance and build momentum
•
Establish shared need, values and vision
•
Recognize, reward and celebrate successes
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
A journey rather than a destination
Over 60% of quality efforts fail. To be among the successful
40%, pay attention to the people side of change.
The Effectiveness (E) of the
result is equal to the Quality (Q)
of the solution times the
Acceptance (A) of the idea.
Six Sigma is a solid approach, but not a “magic bullet” -Transforming healthcare will also likely require changes in
technology, legislation/regulation, transparency and culture.
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative
Additional Resources
Expectations and Questions?
Eckes, G. (2001) The Six Sigma Revolution.
John Wiley and Sons, NY.
Pande, P., R. Neuman, and R. Cavanagh.
(2000) The Six Sigma Way. McGraw-Hill, NY
Pande, P., Holpp, L. (2002) What is Six Sigma?
McGraw-Hill, NY
Snee, R., Hoerl, R. (2003) Leading Six Sigma.
FT Prentice Hall, NY.
iSixSigma Healthcare Portal –
www.healthcare.isixsigma.com
International Society of Six Sigma
Professionals – www.isssp.com
Inside Quality – www.insidequality.com
GE Healthcare’s Performance Solutions –
www.gehealthcare.com/hcs
The Quality Colloquium
Introduction to Track IC:
Six Sigma as a Healthcare Quality Initiative